A Virginia Commonwealth University lab tested nine commercially available cannabidiol (CBD) e-liquids and discovered that while all nine contained CBD, four also unexpectedly contained a synthetic cannabinoid that has been linked to deadly overdoses, and one contained an unadvertised chemical found in cough syrup.

Peace’s lab, which conducts research on illicit drug use and e-cigarettes, was contacted by an individual after he vaped a CBD e-liquid and became intoxicated.

CBD oils are non-psychoactive or less psychoactive than THC-dominant strains used by patients for treatment of inflammation, pain, anxiety, psychosis, seizures, spasms and other conditions. This year, Virginia has granted five state businesses permission to manufacture and sell CBD products to patients who are registered with the state and have been approved by a doctor.

“CBD is not supposed to make you high, but it has purported medical benefits,” Peace said. “So when this person said they vaped this product and had a really awful high, we thought, ‘Wow, there is definitely something in there that shouldn’t be.’”

Peace — along with collaborators Justin Poklis and former graduate student Haley Mulder, who is now pursuing a doctorate in theSchool of Pharmacy— ordered one of each of the CBD products directly from the same distributor as the person who complained about getting high.

The researchers ran the CBD e-liquids through Direct Analysis in Real Time Mass Spectrometry (DART-MS) and Gas Chromatography Mass Spectrometry (GC/MS) to analyze the contents. In addition to CBD in all nine samples, they detected the synthetic cannabinoid 5-fluoro MDMB-PINACA (5F-ADB) in four e-liquids and dextromethorphan (DXM) in one.

5-fluoro MDMB-PINACA (5F-ADB) is a synthetic cannabinoid that has been linked to a series of five non-fatal clinical intoxications after smoking “Spice” or “herbal preparation” to cause anxiety, confusion, psychomotor agitation, psychosis and tachycardia. And in 2014, the Drug Enforcement Agency reported 2,311 incidents involving medical intervention or death linked to 5F-ADB, resulting in its classification as a Schedule I drug in January 2017. It is No. 13 with 6,951 reports on the National Forensic Laboratory Information System list of most common drugs identified in crime labs in 2017.

Dextromethorphan is commonly found in cough suppressants and over-the-counter cough and cold syrups and other medicines.

“The website where these e-liquids were purchased stated that these products were ‘100% natural CBD extracts’ [sic] and provided no indication that these products contained any other active substances,” the study said. “The detection of THC in two products was expected as CBD products may contain up to 0.3% THC, and both naturally occur in cannabis plant material. However, the detection of 5F-ADB and DXM was unexpected. The addition of 5F-ADB and DXM compounds to the CBD products may lead to unexpected psychoactive effects.”

“[This study] is a real call to action,” Peace said. “Physicians are prescribing CBD products. Anybody involved in public health or public safety needs to be aware of what’s potentially in these products.”

Peace said the study underscores the need for federal regulation of the CBD industry. Specifically, she said, she would also like to see federal oversight of the labs responsible for quality control and safety.

“Currently, the industry is self-policing,” she said. “Without federal regulations guiding the oversight and protections of the general public, then there is going to be opportunity for abuse that is really going to put public health and public safety at risk.”